1 Introduction

This introduction specifies for whom these guidelines are written and what the purpose of the hygiene requirements is. It also explains why hygiene is important. You can also find a readers’ guide here.

What is the aim of these guidelines?

These Hygiene Guidelines set out standards and advice that can limit the spread of infectious diseases such as sexually transmitted infections (STIs). By adhering to these standards and advice, hygiene requirements that may be imposed at the municipal level will also be met. You can also include these hygiene guidelines in your business plan.

Who are these hygiene guidelines for?

These hygiene guidelines are intended for:

• Managers and owners of sex businesses In these hygiene guidelines, the term 'sex businesses' refers to all commercial spaces where sexual activity takes place. This includes:
  1. businesses where sex workers engage in sexual activity, such as sex establishments, brothels, window prostitution, prostitution hotels, sex clubs and private houses;
  2. businesses that facilitate sexual acts (without the presence of sex workers). This includes sex saunas, erotic massage parlours, SM studios, sex cinemas, sex theatres and swingers' clubs.
• Self-employed and ‘opting-in’ sex workers These hygiene guidelines are based on the assumption that an independent sex worker and sex workers who work on an ‘opting-in’ basis work as freelancers and that there is no employer-employee relationship. It is assumed that the freelancer and the client (landlord/manager/owner) will reach agreements regarding the implementation of the advice and standards outlined in these guidelines. These guidelines will use the term 'independent sex worker' in order to refer to these categories. This also includes sex workers who work on an opting-in’’ basis.

Responsibilities

The manager or owner of a sex business is an employer if he or she employs staff. The manager/owner is obliged to ensure that his or her employees (e.g. bar staff and cleaning staff*) can work hygienically. This means, among other things, that the manager/owner provides appropriate personal protective equipment free of charge. The manager/owner also keeps employees informed regarding hygiene measures. If it comes to the notice of the manager/owner that an employee is conducting himself/herself in a way that is not hygienic, the manager/owner must take action. This could involve talking to the relevant employee about this issue, for example.

The landlord/agency must, in accordance with the Working Conditions Act, reach agreements with the independent sex worker to ensure that he/she can work safely. This may include reaching agreements regarding who is responsible for the availability of condoms, towels and cleaning materials. But also regarding who is responsible for cleaning the rooms and any objects used during sex.

Due to their respective responsibilities, both the managers and owners of sex establishments and independent sex workers should read these guidelines. However, some sections are more relevant for sex workers while other sections are more relevant for the managers and owners of sex businesses, irrespective of whether sex workers are present.

• Section 2 ‘Safe sex and personal hygiene' is intended for anyone who engages in sexual activity and anyone who is responsible for informing sex workers and employees about hygiene and safe sex.
• Section 3 'Cleaning and disinfecting rooms and objects' is important for anyone who is (ultimately) responsible for cleaning of rooms, furniture and objects used during sex.
• Section 4 ‘Building and facilities’ is aimed particularly at the managers and owners of sex businesses.
• Section 5 'Information and rules of conduct' is important for both sex workers and managers or owners.

* If an external cleaning contractor is used, the operator/owner of the sex business has to inform the contractor about these hygiene guidelines. However, the operator/owner remains responsible for ensuring a safe working environment for sex workers.

Hygiene and pathogens

During sexual activity, sex workers and clients may become infected by STIs such as chlamydia, syphilis, gonorrhoea, hepatitis B, hepatitis C or HIV. Employees, such as cleaners, may also become infected during the course of their work. This can happen by, for example, touching an object which has semen on it. Chlamydia, syphilis and gonorrhoea are caused by bacteria, hepatitis B and C and HIV by viruses. If you become ill due to bacteria, fungi, parasites or viruses, this is known as an infectious disease. Good hygiene can prevent the spread of these pathogens.

Bacteria and viruses are invisible to the naked eye. They can be found everywhere: on the skin, in body fluids such as semen and blood, in lubricant or massage liquid after use, on furniture and objects, in the air, in water, on and in food. The majority of bacteria and viruses are harmless or even useful to humans, but some can cause diseases.

These pathogens can spread from one person to another through bodily contact. If they then multiply, they can cause illness. Whether exposure causes an infection depends on various factors:

• the amount of pathogen(s) required to infect a person;
• how easily the pathogen makes people ill;
• the person's physical condition; while one person may become ill, another may just feel unwell and a third person may have no problems at all.

How are pathogens spread?

• via the hands;
• via body fluids (including semen, blood, saliva, vomit, faeces, urine, vaginal fluid);
• through the air (e.g. droplets expelled when coughing, flakes of skin or dust);
• via objects (sex toys, chairs, door handles and other objects that people touch with their hands);
• via food and water;
• via animals (pets, pests).

Regulations and permits

The municipality decides whether a sex business requires a permit. As part of the application process, the municipal public health service (GGD) may be asked to assess the hygiene of a sex business. The inspectors of the GGD will then check whether the business complies with the hygiene requirements set out in these guidelines. The General Municipal Bylaw (APV) of a municipality may state that the GGD, or another inspector appointed by the municipality, will continue to monitor hygiene on a regular basis after the permit is granted.

These guidelines refer to legislation such as the Buildings Decree and the Working Conditions Act. No references are made to the forthcoming Regulations of Prostitution and Combating Abuses in the Sex Industry Act (Wrp). At the time when these guidelines were being revised, it was still unclear which rules would be incorporated into this act and when the act would take effect.

Readers’ Guide

Hygiene standards are included in sections 2, 3, 4 and 5.

Compliance with the hygiene standards in these sections may be verified by the GGD when issuing permits. You may only deviate from these standards if you apply a comparable or better alternative. The inspector of the GGD will determine whether a method, procedure or resource is a comparable or better alternative.

Where the text refers to the ‘GGD’, this refers to your specific locality. Please visit www.ggd.nl for the contact details for your local municipal public health service.

In the annexes, you will find some examples for cleaning schedules and instructions for hand hygiene, ready to print for immediate use. At the back of the guidelines, there is an overview of additional information and a glossary. 

2 Safe sex and personal hygiene

Why? Safe sex and personal hygiene help to reduce the risk of sexually transmitted infections (STIs) and reduce contact with other pathogens.

Who for? The standards and advice in this section apply to both the managers and owners of sex businesses and to sex workers. Managers and owners are responsible for informing sex workers and employees about hygiene and safe sex.

2.1 Hand hygiene

Why? One of the most common routes by which pathogens are spread is via the hands. The risk of infection is reduced by cleaning hands at the right time and in the right way.

How? Wash your hands with soap and water.

2.2 A clean body

You can get STIs from pathogens present in semen, pre-ejaculatory fluid, vaginal fluid, blood and mucous membranes. Pathogens can also survive for some time outside the body. This means that you can get STIs through body fluids present on your hands or skin. You can also become infected through body fluids on other materials - on a mattress or towel, for instance. Or because body fluids are present in used lubricant or massage fluid. For this reason, please observe the standards in section 2.1, as well as the following standards:

2.3 Hygiene regarding sex toys and other objects

STIs can survive outside the body for some time. For example, when body fluids are present in used lubricant or massage fluid. This means it is important to take care with objects and surfaces where body fluids are present or where lubricant or massage fluid is present. When body fluids enter the mouth, anus or vagina or come into contact with a wound or abrasion, you or your client risk contracting an STI. This relates to the mattress and cover, sex toys (vibrators, dildos), objects that you have used during sex (BDSM equipment, speculum) or rinsing equipment for vaginal and anal douching.

2.4 Condoms and lubricants

Why? To prevent infection with STIs.

Which condoms? It is best to use latex condoms or condoms made of polyurethane. Both latex and polyurethane condoms are suitable for vaginal, anal and oral sex.

The skin of a neovagina (after gender realignment surgery) may become sore or irritated. For a neovagina, it is advisable to use polyurethane condoms with a lubricant based on grease or oil. If you still prefer to use a water-based lubricant or silicone-based lubricant, rinse your neovagina after sex.

General

Condoms

2.5 STI research

Sex workers are advised to get tested for STIs regularly. This can be done at your GP or at the STI outpatient clinic of the GGD in your local area. Get tested four times a year. STIs can lead to health problems if they are left untreated. It is also possible that you may not experience symptoms of an STI immediately, but only later.

Most STIs can be treated. However, some STIs do not show up for two to three weeks. So it is possible that you will have to be tested for HIV, syphilis and hepatitis B at a later date and, if you are an MSM sex worker, also for hepatitis C. Get tested if you notice any symptoms (such as itching, pain, an unusual discharge or skin lesions) or if the condom tore or slipped off during sex.

Are you worried that you or a client might have an STI? Stop working and have a check-up for STIs with your GP or the GGD. Lesions, blisters or warts on your client’s genitals may be an indication of an STI.

If you or your client have a piercing in the mouth or the genitals which has not fully healed, do not have sex. There is a higher risk that you or your client will catch or pass an infection. You can recognise new piercings from red or swollen skin around the piercing, or from pus, blood or scabs around the piercing.

2.6 Vaccination against STIs

You can be vaccinated against hepatitis A and hepatitis B. These vaccinations do not protect you against other STIs such as chlamydia or HIV. It therefore remains important to use a condom. You can get vaccinated at the GGD, for example. Vaccination against hepatitis B is free for sex workers.

2.7 Working when you are ill

If your symptoms include vomiting or diarrhoea, do not work. There is a high risk that your client will also become ill. Preferably, do not work if you are sick. This will prevent you from transmitting pathogens to other people such as your clients.

2.8 Working when you are menstruating

STIs can be transmitted through menstrual blood during your monthly period. It is therefore preferable not to work during your period. If you want to work anyway, use a sponge that is specifically intended for use during menstruation. These sponges do not protect you against STIs, so a condom is still needed.

2.9 Shaving clients

Some clients want to be shaved. This can lead to small skin abrasions. STIs can be spread via any bleeding from these abrasions. Sometimes these abrasions are so small that you cannot see them. However, some bleeding can still occur. Always stick to the following standards when shaving clients:

2.10 Wounds or abrasions

If you have a wound or abrasion and another person’s body fluids come into contact with that wound, there is a higher chance of becoming infected with an STI. But there is also a risk if the other person has a wound or abrasion: you can get infected if blood from another person ends up in your vagina, anus or mouth. So take action immediately if you or your client gets a wound or abrasion.

A graze or scab does not pose such a risk, because these are not open so there is no bleeding.

Skin wounds and abrasions

Wounds in mucous membranes (the inside of the mouth, vagina and anus)

2.11 Fisting

When fisting, there is a chance that the vagina or anus may tear and bleed. If you fist your client when you have small wounds or abrasions on your hands, such as torn skin next to a fingernail, you run the risk of becoming infected with an STI. Follow these steps in order to minimise the risk of infection:

2.12 Golden shower and scat

Sometimes, for example with a golden shower, urine may be swallowed. Urine is usually sterile. This means that it does not contain pathogens. However, when someone has an STI, blood can come out with the urine, and the STI can be transferred to anybody who drinks the urine.

Excrement contains many bacteria and viruses, so it is not safe to eat during scat sex. Bacteria may also be transmitted through (small) wounds or abrasions.

2.13 Activities that can damage or pierce the skin

Some sexual activities involve piercing or damaging the skin, inserting a catheter or injecting a fluid. These hygiene guidelines do not relate to the safety risks or regulations that may be relevant during such activities.

If you and/or the client engage in activities that involve piercing or damaging the skin, make sure that all materials used are sterile and that the method used is hygienic. You can find more information about this in the Hygiene Guidelines for Piercing issued by the National Centre for Hygiene and Safety (LCHV).

3 Cleaning and disinfecting

Why clean? Cleaning reduces the chance of illness. Dirt and dust can contain pathogens. Cleaning reduces the amount of dust and dirt present. This can include vacuuming or mopping. Most of the pathogens in the dust and dirt are usually also removed using these methods.

Why disinfect? Disinfection eliminates any pathogens still present after cleaning. Pathogens may be contained in body fluids such as semen and blood. Even after cleaning, residues of body fluids may still be present, meaning that pathogens may also still be present. This is why disinfection is necessary.

Who for? For everyone who has (overall) responsibility for cleaning and disinfecting areas where sexual activity takes place or cleaning the objects used during sexual activity. This primarily means the managers or owners of sex businesses and independent sex workers. The manager or owner of the sex business must notify those responsible for cleaning, including any external cleaning contractors, of the standards and advice set out in this section, so that they can work hygienically.

3.1 Cleaning rules and techniques

General rules

Using cleaning materials

Using microfibre cloths

When microfibre cloths are used in the right way, they absorb dirt and pathogens better than regular cloths. You can use microfibre cloths both dry and wet. Moist microfibre cloths work a little better.

3.2 Using a cleaning schedule

3.3 Disinfecting surfaces and materials

Disinfecting with a disinfectant kills as many pathogens left behind after cleaning as possible. The Dutch Board for the Authorisation of Plant Protection Products and Biocides (Ctgb) and the European Chemicals Agency (ECHA) assess whether a disinfectant works well and is safe. They also determine where, what and how it may be used, which can be found in the instructions for use on the label. An authorised product can be recognised by its label containing a five-digit number followed by the letter N (e.g. 23456N) or by the letters EU European Union (European Union) or NL followed by 11 digits (e.g. NL-1234567-0001). 

In case of several sick people in a short time (outbreak), always contact the GGD.

Disinfection after cleaning is necessary whenever body fluids such as blood or semen have come into contact with an object (such as a sex toy, swing, sling, etc.) or a surface (table, bench, chair, bath). Body fluids may also end up on objects or surfaces via lubricant or massage oil. Disinfection eliminates any pathogens that are present.

Try to prevent any pathogens from ending up on objects or surfaces, wherever possible. You can minimise this risk by:

• using a condom for sex toys;
• placing towels or waterproof sheets on beds or upholstered furniture.

Disinfection is only necessary in the areas of objects and surfaces that body fluids have come into contact with or that lubricant or massage fluid have come into contact with. There is no need to disinfect the entire surface.

3.4 Dirty laundry

Dirty laundry may be contaminated with pathogens. For this reason, always apply the following standards:

3.5 Waste disposal

Waste can be a source of pathogens and can attract pests. Ensure that the storage and disposal of waste meet the following standards:

Domestic waste

Sharp objects

Dispose of sharp objects, such as razor blades and needles, in an appropriate container. This minimises the risk that those who collect or transport the rubbish may cut themselves. 

You can only return full needle containers to collectors with a VIHB number. The contact details of collectors with a VIHB (transporters, collectors, dealers and brokers of waste substances) number can be found on niwo.nl. 

4 Design and layout of business premises

Why? Keeping your business premises clean is an important part of preventing the spread of pathogens. The layout and design affect the ease with which this is possible. For example, smooth walls are easier and quicker to clean than walls with a rough texture.

Who for? The standards and advice regarding the design and layout of business premises are aimed particularly at the managers and owners of sex businesses.

The Buildings Decree includes a number of requirements for the design and layout of buildings. Municipalities may impose additional requirements regarding the premises of sex businesses. Always comply with the requirements of the municipality, even if those requirements deviate from the standards and advice set out below.

4.1 General standards

4.2 Areas where sexual activity takes place

Places where sexual activity takes place include rooms where prostitutes work with clients, dark rooms, sex cinemas and relaxation cabins. Pathogens may be present in these areas in residual lubricant, or semen or blood stains on the furniture and walls, for instance.

Ensure that these areas meet the following standards:

4.3 Toilets

The toilet area should be easy to clean. This is only the case if walls and floors are smooth and do not absorb moisture. Moisture is the perfect breeding ground for pathogens. Every person who uses the toilet should be able to wash their hands afterwards. For this reason, please observe the standards:

4.4 Showers and bathroom

Sex workers and their clients must be able to wash and shower before and after sex.

4.5 Saunas, steam cabins, pools and bubble baths

STIs can be spread through semen, blood or other body fluids in the bath (water). It should therefore be possible to clean pools, baths and sauna facilities thoroughly.

If you provide bathing facilities, you might have to comply with the Environmental Activities Decree.

In this context a bathing facility is a water retaining structure intended for swimming or bathing, for example a swimming pool or a jacuzzi. The Environmental Activities Decree does not apply to bathing facilities:

• in households, like bathtubs or showers;
• in bathrooms or separate spaces in lodgings (e.g. like hotel rooms);
• that are set up on location for a maximum of 24 consecutive hours;
• intended for contact between humans and animals;
• on board of ships that are not permanently unmoored.

However, the Environmental Activities Decree does apply to rented pools and baths.
The provincial authority has to be informed about pools and baths that fall under the Environmental Activities Decree.

4.6 Kitchen

4.7 Prevention of legionella

Legionella is a bacterium that can cause a lung infection. People can become ill by inhaling very small water droplets in which these bacteria spread from place to place. Jacuzzis and showers are examples of the way in which the bacteria can spread.

Most bathing facilities where water is vaporized must implement legionella prevention measures. Check paragraph 4.5 to see if this applies to your facility. Legionella sampling procedures won’t be necessary if the water is refreshed after every use. However, if the facility is used by multiple users, either simultaneously or consecutively, the Environmental Activities Decree applies. A bath that is used once does have to disinfected daily and rinsed with drinking water (see article 15.48). Furthermore, the provincial authority has to be informed about this activity.

5 Information and rules of conduct

Who for? The information in this section is important for everyone. These standards relate to the managers and owners of sex businesses, but the information is also relevant for sex workers.

5.1 Information

There is a great deal of information available for sex workers about STIs, safe sex and hygienic working methods. For example, information for sex workers on several subjects can be found on sekswerk.info. 

5.2 Rules of conduct

Practising safe sex reduces the risk of STIs. Sex education is the first step towards safe sex practices. But knowledge is not enough on its own. Sex workers must feel able to work safely, and not feel inhibited about insisting on safe sex. They should not be afraid to refuse clients, decline to take part in certain activities or get tested for STIs. Setting ‘house rules’ for clients, and displaying these prominently, can help in this regard.

Annexes

Annex 1. Cleaning schedules

This annex provides some examples of cleaning schedules. Not everything in the schedules may be applicable in your situation; you can change the schedules to suit your situation.

Where the standards mention how often cleaning should take place, this should be adhered to. Of course, you can clean more often than the schedule states, but if you want to clean less often or use a different method, you can only do so if you have a good reason (for example: a particular area is temporarily out of use).

One standard that should always be applied is: always clean immediately whenever an object or area is visibly dirty. This applies to all rooms, surfaces, appliances and objects mentioned in the cleaning schedule.

The other cleaning frequencies mentioned are advisory.

These schedules are shown on separate pages, so you can print them out more easily. You can display them in the cleaning cupboard, for example.

The cleaning schedules from this guideline can be downloaded here as a Word document.

Annex 2. Instructions for hand hygiene

Pathogens are everywhere: on door handles, tables, telephones and other objects, devices and materials. One of the most common routes by which pathogens are spread is via the hands. By washing your hands, you reduce the chance that you or someone you work with will become ill.

Wash your hands:

• before and after any sexual contact or massage;
• if there are body fluids such as semen, pre-ejaculatory fluid, vaginal fluid or blood on your hands;
• if there is any lubricant or massage liquid on your hands;
• after using the toilet;
• before and after preparing food or eating;
• after disposing of gloves;
• after doing any cleaning work;
• if your hands are visibly dirty

Wash your hands as follows:

• Wet your hands.
• Apply liquid soap from a dispenser to your hands.
• Rub the soap for at least 10 seconds. Make sure you rub your thumbs, fingertips, wrists and the areas between your fingers.
• Rinse the soap away.
• Dry your hands and wrists using a disposable paper towel.
• If you do not have no-touch taps, turn the tap off with your elbow or the disposable towel. 
• Discard the paper towel.

Het schema Instructies handhygiëne kunt u hier downloaden als pdf.

More information

• Soa Aids Nederland: www.soaaids.nl. Expertise centre for HIV/AIDS and other STIs.
• Information about prostitution in the Netherlands: www.prostitutie.nl. The Soa Aids Nederland website provides all kinds of information about safe working practices, such as information about free STI testing and free hepatitis B vaccination.
• MAN tot MAN: www.mantotman.nl. Man tot Man is a website provided by Soa Aids Nederland, GGD Amsterdam and GGD Rotterdam-Rijnmond.
• Hygiene Code for the restaurant and hotel sector: https://www.khn.nl/hygienecode.
• Information about working conditions: www.arboportaal.nl.
• EHBO/the Oranje Kruis: www.ehbo.nl.

Also check the website of your Municipal Public Health Service (GGD) for information relevant to your area. You can search for a GGD location near you at https://www.ggd.nl/.

Glossary

Publishing information

The Hygiene Guidelines for Sex Businesses and Sex Workers were revised extensively in 2018 (English translation: early 2019). The following municipal public health services and organizations have contributed to the 2018 revision:

• GGD Amsterdam
• GGD Brabant-Zuidoost
• GGD Gelderland-Zuid
• GGD Haaglanden
• GGD Hollands Midden
• GGD Hollands Noorden
• GGD Limburg Noord
• P&G292
• PROUD (union formed by sex workers)
• Soa Aids Nederland
• SOR Amsterdam
• Vereniging Exploitanten Relaxbedrijven (VER)
• VGGM

Changes since last revision:

• September 2021: Section 5.1 Information has been updated.
• October 2021: Reference to NVZ list with suitable disinfectants has been removed, because it was no longer up to date.
• January 2023:  Replaced expired hyperlink to the bandage guidelines of the Oranje Kruis with a new hyperlink.
• January 2023: Section 3.3 Disinfecting surfaces and materials has been updated. Section 3.4 Which disinfectants can be used? has been deleted. Some tips are included in section 3.3.

• February 2024:  Paragraphs that mention the Building Decree and the Bathing Establishments and Swimming Facilities (Hygiene and Safety) Decree have been changed due to implementation of the Environment and Planning Act. The Building Decree has been replaced by the Environment Buildings Decree. The Bathing Establishments and Swimming Facilities (Hygiene and Safety) Decree has been replaced by section 15 of the Environmental Activities Decree. All external links have been checked. The link regarding information about cleaning neovaginas has been changed and now refers to the website Amsterdam Center for Sex Workers (see paragraph 2.2). 

The Hygiene Guidelines for Sex Businesses and Sex Workers are published by:
National Institute for Public Health and the Environment
National Centre for Hygiene and Safety
Postbus 1 | 7200 BA Bilthoven
E-mail: lchv@rivm.nl 
Web: www.lchv.nl